Breast reconstruction following mastectomy: an update.

Breast reconstruction today is a realistic and vital part of total breast cancer treatment. All physicians should be well informed on current methods of reconstruction so that they can present the facts to their patients in an encouraging, yet realistic manner. Recent developments in breast reconstruction after mastectomy have included the increase utilization of immediate breast reconstruction at the time of mastectomy, the improvement and refinement of the TRAM flap, the increased use of the "free" flap transfer of the TRAM flap which increases blood supply to the flap, texturing of implants which appears to increase their stability on the chest wall and reduce the incidence of capsular contracture or firmness, and the introduction of the newer autogenous tissue methods including the LTTF, gluteal, and latissimus dorsi flaps. Plastic surgeons are charged with the task of becoming proficient in breast reconstruction procedures in order to offer the mastectomy patient a safe, realistic facsimile breast that will be trouble free. Fortunately, there are several good options for restoring the breast after mastectomy. The method of reconstruction should be chosen by matching the desires of informed patients with the indications and contraindications in each case. In general, silicone reconstruction is expedient and satisfactory in most patients. However, it cannot compete with autogenous tissue transfer for severe chest wall defects, covering irradiated areas, creating a large, ptotic breast, or providing a natural appearing, soft breast mount.